Estudio de la utilización de colistina asociada con carbapenemas en los servicios de medicina interna del Hospital Nacional Edgardo Rebagliati Martins en el 2018

El uso de la asociación de colistina con carbapenem es frecuente en la práctica clínica para infecciones por bacterias Gram negativas multirresistentes, sin embargo, existe la necesidad de realizar estudios de utilización con estudios de perfil de resistencia microbiana actualizados para mejorar el uso racional de los antimicrobianos. La investigación realizada describe las características de la utilización de la asociación de colistina con carbapenem para infecciones hospitalarias en los servicios de medicina interna del HNERM del 2018. Se realizó un estudio observacional, descriptivo y retrospectivo de serie de casos. Los datos de 71 historias clínicas que fueron recogidos en una ficha ad-hoc de los servicios de hospitalización de medicina interna del HNERM de enero a diciembre del 2018. Encuentra que el 23.7% fueron terapias empíricas, 63.2% de las terapias en total iniciaron con una dosis de carga de 300 mg de colistina y 40.9% utilizó 150 mg de colistina cada 12 horas con 2 g de meropenem cada 8 horas. El principal diagnóstico para el tratamiento definitivo fue ITU por P. aeruginosa MDR (18.97%), así como para el tratamiento empírico fueron la neumonía e ITU por bacterias gram negativas MDR con 22.22% en ambos casos. El consumo de colistina y meropenem en la asociación antibiótica fue de 0.7 y 1.6 DDD/100 camas-días respectivamente. Concluye que la asociación colistinacarbapenem fue iniciada como terapia definitiva 76.3% y las terapias utilizadas para IVRB e ITU en medicina interna fue del 63.16 %, empleando durante el año un consumo de 0.7 y 1.6 DDD/100 camas-días de colistina y meropenem respectivamente

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Measurement of Non-prompt D0\rm D^0-meson Elliptic Flow in Pb-Pb Collisions at sNN\sqrt{s_{\rm NN}} = 5.02 TeV

International audienceThe elliptic flow ($v_2$) of $\rm D^0$ mesons from beauty-hadron decays (non-prompt $\rm D^0$) was measured in midcentral (30-50%) Pb-Pb collisions at a centre-of-mass energy per nucleon pair $\sqrt{s_{\rm NN}}$ = 5.02 TeV with the ALICE detector at the LHC. The $\rm D^0$ mesons were reconstructed at midrapidity ($|y|<0.8$) from their hadronic decay $\mathrm{D^0 \to K^-\pi^+}$, in the transverse momentum interval $2 < p_{\rm T} < 12$ GeV/$c$. The result indicates a positive $v_2$ for non-prompt $\rm D^0$ mesons with a significance of 2.7$\sigma$. The non-prompt $\rm D^0$-meson $v_2$ is lower than that of prompt non-strange D mesons with 3.2$\sigma$ significance in $2 < p_{\rm T} < 8$ GeV/$c$, and compatible with the $v_2$ of beauty-decay electrons. Theoretical calculations of beauty-quark transport in a hydrodynamically expanding medium describe the measurement within uncertainties

Skewness and kurtosis of mean transverse momentum fluctuations at the LHC energies

International audienceThe first measurements of skewness and kurtosis of mean transverse momentum ($\langle p_\mathrm{T}\rangle$) fluctuations are reported in Pb$-$Pb collisions at $\sqrt{s_\mathrm{NN}}$ = 5.02 TeV, Xe$-$Xe collisions at $\sqrt{s_\mathrm{NN}}$$=$ 5.44 TeV and pp collisions at $\sqrt{s} = 5.02$ TeV using the ALICE detector. The measurements are carried out as a function of system size $\langle \mathrm{d}N_\mathrm{ch}/\mathrm{d}\eta\rangle_{|\eta|<0.5}^{1/3}$, using charged particles with transverse momentum ($p_\mathrm{T}$) and pseudorapidity ($\eta$), in the range $0.2 < p_\mathrm{T} < 3.0$ GeV/$c$ and $|\eta| < 0.8$, respectively. In Pb$-$Pb and Xe$-$Xe collisions, positive skewness is observed in the fluctuations of $\langle p_\mathrm{T}\rangle$ for all centralities, which is significantly larger than what would be expected in the scenario of independent particle emission. This positive skewness is considered a crucial consequence of the hydrodynamic evolution of the hot and dense nuclear matter created in heavy-ion collisions. Furthermore, similar observations of positive skewness for minimum bias pp collisions are also reported here. Kurtosis of $\langle p_\mathrm{T}\rangle$ fluctuations is found to be in good agreement with the kurtosis of Gaussian distribution, for most central Pb$-$Pb collisions. Hydrodynamic model calculations with MUSIC using Monte Carlo Glauber initial conditions are able to explain the measurements of both skewness and kurtosis qualitatively from semicentral to central collisions in Pb--Pb system. Color reconnection mechanism in PYTHIA8 model seems to play a pivotal role in capturing the qualitative behavior of the same measurements in pp collisions

Photoproduction of K+^{+}K−^{-} pairs in ultra-peripheral collisions

International audienceK$^{+}$K$^{-}$ pairs may be produced in photonuclear collisions, either from the decays of photoproduced $\phi (1020)$ mesons, or directly as non-resonant K$^{+}$K$^{-}$ pairs. Measurements of K$^{+}$K$^{-}$ photoproduction probe the couplings between the $\phi (1020)$ and charged kaons with photons and nuclear targets. We present the first measurement of coherent photoproduction of K$^{+}$K$^{-}$ pairs on lead ions in ultra-peripheral collisions using the ALICE detector, including the first investigation of direct K$^{+}$K$^{-}$ production. There is significant K$^{+}$K$^{-}$ production at low transverse momentum, consistent with coherent photoproduction on lead targets. In the mass range $1.1 < M_{\rm{KK}} < 1.4$ GeV/$c^2$ above the $\phi (1020)$ resonance, for rapidity $|y_{\rm{KK}}|<0.8$ and $p_{\rm T,KK} < 0.1$ GeV/$c$, the measured coherent photoproduction cross section is $\mathrm{d}\sigma/\mathrm{d}y$ = 3.37 $\pm\ 0.61$ (stat.) $\pm\ 0.15$ (syst.) mb. The centre-of-mass energy per nucleon of the photon-nucleus (Pb) system $W_{\gamma \mathrm{Pb, n}}$ ranges from 33 to 188 GeV, far higher than previous measurements on heavy-nucleus targets. The cross section is larger than expected for $\phi (1020)$ photoproduction alone. The mass spectrum is fit to a cocktail consisting of $\phi (1020)$ decays, direct K$^{+}$K$^{-}$ photoproduction, and interference between the two. The confidence regions for the amplitude and relative phase angle for direct K$^{+}$K$^{-}$ photoproduction are presented

Photoproduction of K+^{+}K−^{-} pairs in ultra-peripheral collisions

International audienceK$^{+}$K$^{-}$ pairs may be produced in photonuclear collisions, either from the decays of photoproduced $\phi (1020)$ mesons, or directly as non-resonant K$^{+}$K$^{-}$ pairs. Measurements of K$^{+}$K$^{-}$ photoproduction probe the couplings between the $\phi (1020)$ and charged kaons with photons and nuclear targets. We present the first measurement of coherent photoproduction of K$^{+}$K$^{-}$ pairs on lead ions in ultra-peripheral collisions using the ALICE detector, including the first investigation of direct K$^{+}$K$^{-}$ production. There is significant K$^{+}$K$^{-}$ production at low transverse momentum, consistent with coherent photoproduction on lead targets. In the mass range $1.1 < M_{\rm{KK}} < 1.4$ GeV/$c^2$ above the $\phi (1020)$ resonance, for rapidity $|y_{\rm{KK}}|<0.8$ and $p_{\rm T,KK} < 0.1$ GeV/$c$, the measured coherent photoproduction cross section is $\mathrm{d}\sigma/\mathrm{d}y$ = 3.37 $\pm\ 0.61$ (stat.) $\pm\ 0.15$ (syst.) mb. The centre-of-mass energy per nucleon of the photon-nucleus (Pb) system $W_{\gamma \mathrm{Pb, n}}$ ranges from 33 to 188 GeV, far higher than previous measurements on heavy-nucleus targets. The cross section is larger than expected for $\phi (1020)$ photoproduction alone. The mass spectrum is fit to a cocktail consisting of $\phi (1020)$ decays, direct K$^{+}$K$^{-}$ photoproduction, and interference between the two. The confidence regions for the amplitude and relative phase angle for direct K$^{+}$K$^{-}$ photoproduction are presented

Charged-particle production as a function of the relative transverse activity classifier in pp, p−-Pb, and Pb−-Pb collisions at the LHC

International audienceMeasurements of charged-particle production in pp, p$-$Pb, and Pb$-$Pb collisions in the toward, away, and transverse regions with the ALICE detector are discussed. These regions are defined event-by-event relative to the azimuthal direction of the charged trigger particle, which is the reconstructed particle with the largest transverse momentum ($p_{\mathrm{T}}^{\rm trig}$) in the range $8<p_{\mathrm{T}}^{\rm trig}<15$ GeV$/c$. The toward and away regions contain the primary and recoil jets, respectively; both regions are accompanied by the underlying event (UE). In contrast, the transverse region perpendicular to the direction of the trigger particle is dominated by the so-called UE dynamics, and includes also contributions from initial- and final-state radiation. The relative transverse activity classifier, $R_{\mathrm{T}}=N_{\mathrm{ch}}^{\mathrm{T}}/\langle N_{\mathrm{ch}}^{\mathrm{T}}\rangle$, is used to group events according to their UE activity, where $N_{\mathrm{ch}}^{\mathrm{T}}$ is the charged-particle multiplicity per event in the transverse region and $\langle N_{\mathrm{ch}}^{\mathrm{T}}\rangle$ is the mean value over the whole analysed sample. The energy dependence of the $R_{\mathrm{T}}$ distributions in pp collisions at $\sqrt{s}=2.76$, 5.02, 7, and 13 TeV is reported, exploring the Koba-Nielsen-Olesen (KNO) scaling properties of the multiplicity distributions. The first measurements of charged-particle $p_{\rm T}$ spectra as a function of $R_{\mathrm{T}}$ in the three azimuthal regions in pp, p$-$Pb, and Pb$-$Pb collisions at $\sqrt{s_{\rm NN}}=5.02$ TeV are also reported. Data are compared with predictions obtained from the event generators PYTHIA 8 and EPOS LHC. This set of measurements is expected to contribute to the understanding of the origin of collective-like effects in small collision systems (pp and p$-$Pb)

Femtoscopic correlations of identical charged pions and kaons in pp collisions at s=13\sqrt{s}=13 TeV with event-shape selection

International audienceCollective behavior has been observed in high-energy heavy-ion collisions for several decades. Collectivity is driven by the high particle multiplicities that are produced in these collisions. At the Large Hadron Collider (LHC), features of collectivity have also been seen in high-multiplicity proton-proton collisions that can attain particle multiplicities comparable to peripheral Pb-Pb collisions. One of the possible signatures of collective behavior is the decrease of femtoscopic radii extracted from pion and kaon pairs emitted from high-multiplicity collisions with increasing pair transverse momentum. This decrease can be described in terms of an approximate transverse mass scaling. In the present work, femtoscopic analyses are carried out by the ALICE collaboration on charged pion and kaon pairs produced in pp collisions at $\sqrt{s}=13$ TeV from the LHC to study possible collectivity in pp collisions. The event-shape analysis method based on transverse sphericity is used to select for spherical versus jet-like events, and the effects of this selection on the femtoscopic radii for both charged pion and kaon pairs are studied. This is the first time this selection method has been applied to charged kaon pairs. An approximate transverse-mass scaling of the radii is found in all multiplicity ranges studied when the difference in the Lorentz boost for pions and kaons is taken into account. This observation does not support the hypothesis of collective expansion of hot and dense matter that should only occur in high-multiplicity events. A possible alternate explanation of the present results is based on a scenario of common emission conditions for pions and kaons in pp collisions for the multiplicity ranges studied

Multiplicity dependence of charged-particle intra-jet properties in pp collisions at s\sqrt{s} = 13 TeV

International audienceThe first measurement of the multiplicity dependence of intra-jet properties of leading charged-particle jets in proton-proton (pp) collisions is reported. The mean charged-particle multiplicity and jet fragmentation distributions are measured in minimum-bias and high-multiplicity pp collisions at $\sqrt{s}$ = 13 TeV using the ALICE detector. Jets are reconstructed from charged particles produced in the midrapidity region ($|\eta| < 0.9$) using the sequential recombination anti-$k_{\rm T}$ algorithm with jet resolution parameters $R$ = 0.2, 0.3, and 0.4 for the transverse momentum ($p_{\rm T}$) interval 5$-$110 GeV/$c$. High-multiplicity events are selected by the forward V0 scintillator detectors. The mean charged-particle multiplicity inside the leading jet cone rises monotonically with increasing jet $p_{\rm T}$ in qualitative agreement with previous measurements at lower energies. The distributions of jet fragmentation functions $z^{\rm ch}$ and $\xi^{\rm ch}$ are measured for different jet-$p_{\rm T}$ intervals. Jet-$p_{\rm T}$ independent fragmentation of leading jets is observed for wider jets except at high- and low-$z^{\rm ch}$. The observed "hump-backed plateau" structure in the $\xi^{\rm ch}$ distribution indicates suppression of low-$p_{\rm T}$ particles. In high-multiplicity events, an enhancement of the fragmentation probability of low-$z^{\rm ch}$ particles accompanied by a suppression of high-$z^{\rm ch}$ particles is observed compared to minimum-bias events. This behavior becomes more prominent for low-$p_{\rm T}$ jets with larger jet radius. The results are compared with predictions of QCD-inspired event generators, PYTHIA 8 with Monash 2013 tune and EPOS LHC. It is found that PYTHIA 8 qualitatively reproduces the jet modification in high-multiplicity events except at high jet $p_{\rm T}$. These measurements provide important constraints to models of jet fragmentation